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Published on 19.03.19 in Vol 7, No 3 (2019): March
Preprints (earlier versions) of this paper are available at http://preprints.jmir.org/preprint/10855, first published Apr 23, 2018.
Training Cognitive Functions Using Mobile Apps in Breast Cancer Patients: Systematic Review
Laura Vergani1,2*, MSc ;
Giulia Marton1,2*, MSc ;
Silvia Francesca Maria Pizzoli1,2, MSc ;
Dario Monzani1,2, PhD ;
Ketti Mazzocco1,2, PhD ;
Gabriella Pravettoni1,2, PhD
1Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
2Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
*these authors contributed equally
Laura Vergani, MSc
Department of Oncology and Hemato-Oncology
University of Milan
Via Festa del Perdono 7
Milan, 20122
Email: laura.vergani@ieo.it
Background: Breast cancer is an invalidating disease and its treatment can bring serious side effects that have a physical and psychological impact. Specifically, cancer treatment generally has a strong impact on cognitive function. In recent years, new technologies and eHealth have had a growing influence on health care and innovative mobile apps can be useful tools to deliver cognitive exercise in the patient's home.
Objective: This systematic review gives an overview of the state-of-the-art mobile apps aimed at training cognitive functions to better understand whether these apps could be useful tools to counteract cognitive impairment in breast cancer patients.
Methods: We searched in a systematic way all the full-text articles from the PubMed and Embase databases.
Results: We found eleven studies using mobile apps to deliver cognitive training. They included a total of 819 participants. App and study characteristics are presented and discussed, including cognitive domains trained (attention, problem solving, memory, cognitive control, executive function, visuospatial function, and language). None of the apps were specifically developed for breast cancer patients. They were generally developed for a specific clinical population. Only 2 apps deal with more than 1 cognitive domain, and only 3 studies focus on the efficacy of the app training intervention.
Conclusions: These results highlight the lack of empirical evidence on the efficacy of currently available apps to train cognitive function. Cognitive domains are not well defined across studies. It is noteworthy that no apps are specifically developed for cancer patients, and their applicability to breast cancer should not be taken for granted. Future studies should test the feasibility, usability, and effectiveness of available cognitive training apps in women with breast cancer. Due to the complexity and multidimensionality of cognitive difficulties in this cancer population, it may be useful to design, develop, and implement an ad hoc app targeting cognitive impairment in breast cancer patients.
JMIR Mhealth Uhealth 2019;7(3):e10855
doi:10.2196/10855
cognitive impairment;
breast cancer;
cognitive training;
intervention;
mobile-based interventions
Cancer is a major public health problem worldwide and the second leading cause of death in the United States. In 2017, Siegel and colleagues [1] reported 1,688,780 new cases and estimated 600,920 deaths. Breast cancer is one of the most common cancers around the world [2]. It is the most common cancer diagnosed in women, affecting about 1 in 8 women in the United States during their lifetime (12.4%), and it is the second most common cause of death by cancer in women [3]. The incidence rate is strictly associated with age: 95% of new cases are registered in women older than 40 years; only 1.5 cases per 100,000 are registered in young women (20 to 24 years). The incidence is higher for older women: 421.3 cases per 100,000 women are registered in women 75 to 79 years old; the median age at diagnosis is 61 years [3]. Prognosis is related to cancer stage: 5-year survival rate is 100% for stage 0 and I, 93% for stage II, 72% for stage III, and 22% for stage IV [3]. In the last 20 years, we have witnessed a decline in overall cancer mortality. This is especially true for breast cancer mortality: the death rate steadily decreased by 38% from 1989 to 2014. This is due especially to decreases in smoking and advances in early detection and treatment [1].
The advances made in breast cancer treatment offer women greater prospects of cure and a better quality of life. However, cancer treatment has some deleterious acute or long-term side effects that impact women's physical, functional, emotional, financial, and social lives [4]. Along with depression and anxiety [5], cognitive impairment is a short- or long-term outcome or side effect of breast cancer and its treatment and the treatment of other diseases such as stroke [6], HIV and hemophilia [7], and multiple sclerosis [8]. In recent years, empirical evidence has risen regarding significant cognitive impairment following breast cancer treatments in survivor women. The American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline [9] showed that 75% and 35% of patients report cognitive impairment during treatment and after treatment, respectively. In addition, in everyday clinical practice, women with breast cancer often complain about cognitive difficulties in different domains of cognition. For example, these cognitive impairments include problems with concentration, executive function, memory [9] and, especially in patients treated with chemotherapy, problems with visual memory, information processing speed, and verbal memory [10]. Cognitive impairments could also reduce the quality of life, lead to distress, and have a negative impact on women's working, societal, and family life [9].
Cognitive impairment can have multifactorial causes. Runowicz and colleagues [9] reported that insomnia, depression, fatigue, surgery, anesthesia, different type of cancer treatments and cancer itself could cause cognitive impairment. For example, a meta-analysis conducted by Jim and colleagues [11] showed that breast cancer survivors treated with chemotherapy suffer small and limited observed cognitive deficits. This is especially true for the domains concerning verbal and visuospatial ability. However, other difficulties also concern memory and attention deficits due to chemotherapy. These symptoms, generally known as chemobrain or chemofog, are experienced by a lot of women treated with chemotherapy [4]. Bakoyiannis and colleagues [12] conducted a systematic review on the impact of endocrine therapy on cognitive functions of breast cancer patients. They especially investigated difficulties in 5 cognitive domains: verbal memory, verbal fluency, attention and working memory, motor speed, and psychomotor speed. They concluded that endocrine therapy may alter cognitive functions in these women.
However, the exact mechanism underlying cognitive impairment is not clear. For example, empirical evidence exists on the role of stress and coping styles [13], direct neurotoxic injury, telomere shortening, oxidative stress, cytokine dysregulation, estrogen-mediated effects, genetic polymorphism [14], peripheral proinflammatory cytokines [15], decreased estrogen levels, and structural brain changes [16] in cognitive impairment following cancer treatment.
Moreover, there are uncertainties regarding the nature and magnitude of cognitive impairment in breast cancer patients [17] and also regarding the most effective treatment to target these kinds of cognitive difficulties [9]. In their review on pharmacological and nonpharmacological interventions to manage cognitive alterations after chemotherapy, Chan and colleagues [18] concluded that pharmacological interventions to manage cognitive alterations after chemotherapy for breast cancer are not well supported by current empirical evidence. On the other hand, some kind of cognitive training—computerized cognitive training, cognitive behavioral therapy, memory training, speed of processing training, psychoeducation, Tibetan sound—and physical interventions may be useful. However, further studies are needed in order to provide guidelines and concrete recommendations for clinical practice [18].
Overall, these psychological interventions for cognitive impairment are time- and money-consuming. They may result in a huge burden for patients because they are often delivered in an in-patient context [17]. The development and delivery of home-based or Web-based interventions may have advantages over traditional clinic-based ones. However, there is a scarcity of these kinds of innovative interventions for cognitive training.
Starting with the introduction of the World Wide Web in our daily lives, the internet has increasingly become an essential part of modern living. A recent report by the Pew Research Center states that in the developed nations, the number of people who use the internet or a mobile phone remains high throughout the years (around 86% from 2015 to 2018) and that in the developing world the rate is increasing constantly (from 62% of the population using the internet or owning a mobile phone in 2013 to 64% in 2018) [19]. A common misunderstanding is that the elderly, compared to younger people, are less interested in technology. However, older people are rapidly gaining more interest in the subject [20], and the rate of people aged 65 years and above using the internet grew from 14% in 2000 to 58% in 2015. Internet use for other age groups is growing as well: internet use from 2000 to 2015 increased from 70% to 96% for people aged 18 to 29 years, from 61% to 93% for people aged 30 to 49 years, and from 46% to 81% for people aged 50 to 64 years. These statistics are especially interesting because they could indicate the promise of development of innovative Web-based interventions also targeting elderly people. Traditional health care interventions have been delivered through face-to-face meetings with clinicians. However, eHealth and mHealth uses have increasingly spread in the last decades [21].
The two leading platforms for health-related mobile apps are iOS and Android. As of 2014, more than 100,000 mHealth apps had been released [22,23]. mHealth apps permit real-time and bidirectional interaction with the patient [23]. This transformation brings changes even in the diagnosis and treatment of cancer.
Several mHealth apps have been developed to inform patients; enhance communication, consulting, and symptom self-management and monitoring; and improve health record access and maintenance and clinical decision making [24]. However, little is known about apps directly aimed at improving cognitive functioning in patients reporting cognitive difficulties. No apps have been specifically developed to counteract cognitive difficulties in breast cancer survivors. Thus, we aimed to identify effective apps to train cognitive function and counteract cognitive impairment in both clinical and nonclinical populations. Another aim was to evaluate their efficacy and assess whether they could be also used to counteract cognitive impairment in breast cancer patients. Thus, we focused on their distinctive features in terms of targeted populations and the specific cognitive domains being trained.
Our search strategy was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines [25]. A flowchart of the systematic review is shown in Figure 1.
To identify articles for our review, we searched PubMed and Embase databases for the terms smartphone, mobile, and app. The searched cognitive domains were memory, attention, concentration, verbal fluency, motor speed, psychomotor speed, problem-solving, executive function, visuospatial function, language, and cognitive control. In particular, the string of terms included:
Smartphone app or mobile app
Cognitive function or memory or attention or concentration or verbal fluency or motor speed or psychomotor speed or problem solving or executive function or visuospatial function or language or cognitive control
The search was limited to the English language. No restriction was placed on the year of publication. The search was completed in February 2018.
Two authors independently reviewed the titles and abstracts to identify relevant papers. We extracted only those papers with the main focus on the use of a mobile-based app (mobile phone or tablet-based) to deliver cognitive training. About 10% of the papers were double screened, and disagreements in data extraction were resolved through discussion with a third author.
The second step consisted of a full article screening. We excluded papers that were (1) reviews, case reports, or protocols; (2) abstracts for conferences; or (3) related to apps that assess cognitive functions without training them.
Figure 1. Flowchart of the systematic review.
View this figure
Data collection included information on authors, title, publication date, study aim, sample characteristics, clinical or nonclinical populations, cognitive domains trained, app exercise descriptions, assessment and feedback, app evaluation and efficacy, training with the experimenters, and whether the device was given to the study participants.
Studies Selected
A flowchart of the systematic review is shown in Figure 1. We retrieved a total of 493 articles. We selected 11 articles after a full-text screening. We excluded 2 reviews (eg, [21,26]), 5 case reports (eg, [27-31]), and 4 protocols (eg, [32,33]). The other studies were excluded for content reasons, for example: some studies did not use apps to train cognitive functions [22,34-47], and others were excluded because they used apps only to assess—and not to train—cognitive functions [48-58]. Our 11 selected studies focus on the cognitive domains of attention, memory, problem solving, cognitive control, executive function, visuospatial function, and language (reported in Table 1).
Sample Characteristics
Our search returned 11 studies that include 819 participants. The number of participants in these studies ranged from 9 to 626. Weighted by sample size, the mean age of participants was 36.2 years. However, there is a huge heterogeneity in participant ages among these 11 studies: ages ranged from 50 months to 96 years. In particular, 1 study focused on preschool children with a mean age of 60 months [59], while 4 papers focused especially on older adults with a mean age over 68 years [60-63].
Nearly all of the studies were performed in developed countries. Almost half of the studies (5/11, 45%) were conducted in North America: 4 were performed in the United States [60,61,64,65] and 1 in Canada [63]. Three were conducted in Europe: 2 in Italy [59,66], and 1/11 in Norway [67]. Two studies were conducted in Asia: 1 in Taiwan [62] and 1 in Jordan [68]. Only 1 study was conducted in Oceania (Australia [69]). In addition to this heterogeneity in cultural provenance, the 11 identified studies have a moderate variability in the kind of population in which they evaluated the app for the cognitive training. No studies involved breast cancer patients. Ten of 11 studies involved adults or elderly people. One study focused on adults affected by brain injuries [65], 1 on cognitively impaired patients with multiple sclerosis [66], and 1 on patients with early stages of Alzheimer disease [68]. Three papers focused on healthy elderlies [60-62] while 1 study chose a population of older adults with and without subjective cognitive complaints and mild cognitive impairment [63]. One study focused on adults with mild to moderate depression [64] and 1 on overweight or obese adult [69]. Just 1 paper from our search specified healthy young adults [67]. Only 1 study focused on children with mild to severe language impairments or delays [59]. Inclusion and exclusion criteria were different in all of the studies. Only 3 studies [65,67,69] included control groups.
The majority of the selected papers had a primary aim to evaluate the apps in terms of usability, acceptability, feasibility, and user satisfaction [59-61,63,66-68]. Only 2 articles [62,65] chose to describe the development and improved design of the apps. Only 1 paper [64] had as the main aim to assess and improve depressive symptoms by comparing 3 different apps, 1 of which is explicitly aimed at improving depression through a cognitive control exercise. Just 1 study had the explicit aim of investigating the efficacy of the app in improving cognitive functioning [69].
App Characteristics
App availability on the market was checked by searching in the main app stores (App Store and Google Play); however, none are available to the general public. The same search was conducted on online test catalogs, such as Pearson Assessments or Psychological Assessment Resources Inc, but no apps from the studies were found. In all of the studies, app users were asked to respond with a touchscreen.
Author, year App name Attention Problem solving Memory Cognitive control Executive function Visuospatial function Language
Arean and colleagues, 2016 [64] Project: EVO
Blackburne and colleagues, 2016 [69] NoGo
Bless and colleagues, 2014 [67] — ✓
Hill and colleagues, 2015, and Hill and colleagues, 2018 [60,61] Attention Training Application ✓
Lorusso and colleagues, 2018 [59] —
Lu and colleagues, 2017 [62] Brain Win ✓
Powell and colleagues, 2017 [65] ProSolv
Shellington and colleagues, 2017 [63] Healthe Brain
Tacchino and colleagues, 2015 [66] Cognitive Training Kit (COGNI-TRAcK)
Zmily and colleagues, 2014 [68] ADcope – Spaced Retrieval Exercise
Table 1. App developers, app names, and cognitive domains being targeted in each study.
View this table
Bless and colleagues [67] explored the feasibility and effectiveness of an app that enables people to train auditory attention. They developed the app in-house, but they did not give it a name. Participating in this study were healthy adults; they were given an iPod touch and asked to perform a consonant-vowel dichotic listening task. According to the forced-attention condition of the standard consonant-vowel dichotic listening paradigm, during this task each participant was presented simultaneously with 2 different syllables via earphones: while one was presented to the left ear, the other was delivered to the right. Syllables, made by consonants and vowels, were read by a male, native Norwegian speaker with constant voice intonation and intensity. Before the beginning of the task, each participant was told via message on the display to pay attention only to the syllable delivered to the left or the right ear. After hearing the syllables, participant had to choose the correct syllable from 6 multiple choice answers. Each training session, about 6 minutes long, included 6 blocks with 5 pairs of syllables. Syllables were presented in 400 to 500 ms with an interval of 4000 ms between each pair. At the end of each session, participants were shown feedback of their correct answers. Results were stored on the device and available to the researcher at the end of the study.
Lorusso and colleagues [59] developed an app to improve semantic competence and structural knowledge in children with learning impairments. It was part of an integrated system. The aim of the study was to evaluate learnability, usability, user satisfaction, and the quality of the interaction in children playing with this integrated system. The app was used on a supplied tablet; it scanned the tag that the experimenter had placed under some toys (plastic animals). When the children scanned the tag under the toys, the app displayed a menu with 5 different activities that were all related to this specific animal. The first was an informative activity in which children were given some interesting information about this specific animal. The second one was a storytelling activity that directly connected to a website with stories and tales related to the animal. The third was a visual activity with several picture and photos of this specific animal. The fourth presented a song strictly related to the chosen animal. The last one was a puzzle activity in which children were asked to put together pieces of a puzzle representing this specific animal. The authors chose all these activities because they enrich semantic knowledge and organization. After the completion of each the task, the child was given feedback by picture or sound. The app also provided a text-to-speech tool to listen to written information.
Characteristics of the included studies and related apps are presented in Multimedia Appendix 1 and 2.
Shellington and colleagues [63] examined the feasibility and utility of an app called HealtheBrain, which was focused on improving visuospatial executive function and working memory. Participants of this study were older adults with or without subjective cognitive complaints and mild cognitive impairment. They received HealtheBrain to improve cognitive functioning through a specific physical exercise called Square Step Exercise. Before the beginning of the exercise, the app offered participants the opportunity to have a tutorial about the use of the app and then to calibrate the step length. The square step exercise had 35 progressive stages and the participants had to start to form the first one. In order to go from 1 level to another, the subject had to complete at least 80% of each task. For each step, participants had to memorize 4 to 8 walking and stepping sequences and repeat them. When they reached the goal, an item was added to their virtual garden and they could get to the next level. They were asked to exercise at least 3 times per week over the next 3 weeks, and subjects were invited to contact the researchers with any question or technical issue.
In 2015, Hill and colleagues [60] developed an app to train attention. More recently [61], they decided to improve it considering the problematic issues identified in their previous study. Both studies focused on the usability, acceptability, and feasibility of the Attention Training Application. The experimental design of the study in 2018 was very similar to the pilot study in 2015. Before the start of exercise, 2 preliminary sessions were established: in the first session an examiner met with a participant in order to introduce them to the device (iPad or iPad Mini). Prior to the beginning of the trial, participants could exercise using the device for a week to become familiar with its functioning. The app was then introduced in the second session. Written instruction was given to participants, and they were able to contact the experimenter to receive further information and instructions on the use of the app and device. This app delivered a program targeting attention and was based on the dual n-back training paradigm. This cognitive domain was improved by different exercises: in the first one a visual stimulus was presented, in the second one an auditory stimulus was given, and in the third step visual and auditory stimuli were presented together. The visual stimulus was a grid split in 8 parts with a square in 1 of them. The auditory stimuli were spoken letters. Given that the authors follow the n-back paradigm, the exercise requested subjects to report the correct answer of the exercise presented n trial before. At the end of each trial, the app sends a visual stimulus so the participants know immediately if the answer is the correct one. The Attention Training Application was adaptive: if participants performed well, the exercise increased in difficulty. The differences between the 2 versions of the app consisted mostly in modified elements to help the user better comprehend how to use the app and correctly perform the exercise. In 2018, the authors added some preliminary training features: a first session with the experimenter that presented the iPad and a week to become familiar with the device. Moreover, feedback was modified in the second version. While the 2015 app gave negative feedback to users (a red X indicated each wrong answer), this was removed in 2018 because participants generally reported frustration and confusion with it. Finally, the response time changed from 3 seconds to 5 seconds. The paradigm followed, and the exercise and adaptive style of exercise presentation remained the same.
Lu and colleagues [62] developed a prototype of an app called Brain Win. The app was directed to older people and evolved through 2 cycles of design and evaluation. The app involved 4 tasks and 6 games to train 5 cognitive domains: attention, executive function, memory, language, and visuospatial function. The 6 implemented games directly relate to real-life experience and daily activities of older adults:
My Calendar: discrimination task to train attention, executive function, and memory. Participants identify the correct date and time.
Go to Market: visuomotor task to train attention, executive function, memory, and visuospatial function. Participants draw the route to the market place.
Shopping in the Market: calculation task to train attention, executive function, and memory. Participants buy items with a limited budget and make calculations using the item prices.
Finding Objects During a Phone Call: discrimination task to train attention, memory, language, and executive function. Participants listen and find correct items on the screen.
Super Singer: respelling task to train attention, memory, language, visuospatial function, and executive function. Participants reorganize character cards with song lyrics, listening to or reading them.
Go to the Zoo: discrimination task to train attention, memory, and executive function. Participants recognize and remember the noise made by the zoo animals and identify them.
Each game was supported by visual and auditory instructions. Buttons and icons had a realistic appearance and participants were asked to test the app in their home. Feedback sounds were presented at the end of each task. There was also the possibility to check the game scores or participant's position in a ranking table.
The Arean and colleagues [64] study aimed at testing the efficacy of 3 apps in relieving depressive symptomatology. These 3 apps were called Project: EVO, iPST, and Health Tips. In our review, we are mainly interested in Project: EVO, which trained cognitive control in order to improve cognitive symptoms. The other 2 apps were used to control treatment (Health Tips) and conduct psychotherapy intervention to improve depression (iPST). The participant had to use just 1 of the 3 apps: if they owned a mobile phone but not an iPad, the experimenter gave them one to use. Project: EVO is an exercise to train cognitive control and is designed as a video game. As the participants improved their proficiency with the game over time, the app increased the difficulty of the exercises. The app had an internal system to remind individuals to complete the exercise.
Blackburne and colleagues [69] tested the efficacy of the NoGo app that considered cognitive restraint—and specifically inhibitory control—to be used for weight control in obese adults. In particular, the app trained 3 domains: unhealthy eating, smoking, and alcohol consumption. Each game had 2 distinct tasks: Go and NoGo trials, in which a timer appeared next to an image that remained the same and started to countdown, and the Stop trial, in which participants had to choose the healthy food image as fast as possible. In this exercise, the image changed from healthy to unhealthy after the countdown began. Participants had to tag the correct answer if the Go tone was produced; if the NoGo tone was reproduced instead, participants had to hold back from answering. The stimuli order changed in each game so that the individuals could not anticipate and predict the next image and could not respond based on their previous experience with the game. The difficulty level was modulated by the timer and by the number of images presented (with a maximum of 12 images). The app collected data such as reaction time, game level, correct responses, and errors. The researcher could gain access to the data at the end of the training session.
Powell and colleagues [65] aimed at developing and testing an app called ProSolv, a problem-solving app developed by the authors after focus groups and interviews. In this study, the device was not provided; an inclusion criterion was that each participant must own a mobile phone and have access to the internet. The ProSolv program included 3 steps plus FAQ and help pages. The first was a face-to-face meeting with a coach; during this session, each participant could learn and test the app with the help of the expert and the program manual. In the second, a Web-based tutorial introduced the conceptual model of problem solving and its usefulness in everyday activities. Next, use of the app was explained in a video. The third step consisted of participants using the app to create a problem-solution list and remember each step to solve problems in a more effective way. The app comprised 4 pages: Welcome to the ProSolv app, My problem, My solution, and My contact. With the app, individuals could evaluate each problem-solution on the list by rating it with 1 to 5 stars.
Tacchino and colleagues [66] described the Cognitive Training Kit (COGNI-TRAcK). In their study, the app was used as a cognitive rehabilitation intervention based on working memory exercises in a sample of patients with multiple sclerosis. The authors stated that COGNI-TRAcK could be used to implement 3 types of working memory. The first task targeted visuospatial working memory and presented a sequence of visual stimuli, with participants asked to touch the corresponding location where the stimuli had appeared on the screen. The second task was an operation n-back exercise in which participants were presented with 2 numbers on the screen. If the instruction on the screen said N=0, participants had to touch the sum of the 2 numbers as the right answer. When the instruction said, for example, N=1, they had to touch on the screen the sum of the numbers previously presented. The third was a dual n-back exercise in which each patient was presented with a single number on the screen. Similar to the first n-back task, if the instruction said, for example, N=1, participants had to remember and recall the number presented in the previous exercise by touching it on the screen. All the information collected by the app was directly stored in a database with 3 sections: (1) Patient contained participant data; (2) Exercise and Treatment contained information about the assignment, workload, record of the exercise, and length of the intervention; and (3) Setting contained the characteristics of the configuration of the app. The main feature of the app was the possibility to implement the workload and regulate its intensiveness.
The study by Zmily and colleagues [68] focused on the usability of a subtask of an integrated app named ADcope. The app was developed for mobile devices and aimed to support Alzheimer disease patients in their daily routines. During the study, patients were given a tablet with the app along with clear instructions on how to use the device and app. Patients were asked to perform exercises while sitting together in a room. The app had sections for improving user quality of life and a support module, but for our review, we focused on the third section, which aimed to exercise patient memory in 2 ways. Audio-Assisted Memory Training played audio files of patient biographical information and then quizzed them about the information. The Spaced Retrieval exercise, whose usability was the main focus of the study, comprised 2 phases. The first assessed users' current memory recall ability by presenting them with information followed, after some delay, by a question with 4 multiple choice answers. This exercise could use text information or a simple figure. The difficulty of the exercise could be operationalized by measuring the length of the delay between the information and the quiz. If the individual gave the right answer after a certain period of time, the app would increase the difficulty by increasing the time delay. The training phase (the same as the assessment) comprised 10 questions with a delay length based on the assessment results. After the participant completed the trials, written feedback appeared on the display. The app also has text-to-speech tools enabling patients to have the information read aloud.
Cognitive Domains
As shown in Table 1, the cognitive domains trained by the identified apps are attention, problem solving, memory, cognitive control, executive function, visuospatial function, and language. Nine out of 11 studies considered the usefulness of the app for the training of just 1 cognitive domain at a time (cognitive control [64,69], attention [60,61,67], language [59], problem solving [65], and memory [66,68]). The remaining 2 studies considered more than 1 cognitive function: Lu and colleagues [62] investigated attention, memory, executive function, visuospatial function, and language; Shellington and colleagues [63] investigated memory, executive function, and visuospatial function.
Cognitive Control
Cognitive control was trained in studies by Arean and colleagues [64] and Blackburne and colleagues [69]. Both of these authors stated that app usage could improve cognitive control as a mean to enhance other conditions: depression for Arean and colleagues [64] and obesity for Blackburne and colleagues [69]. Cognitive control in the paper by Arean and colleagues [64] was trained with an app that is designed as a video game that modulates cognitive control abilities. Blackburne and colleagues [69] instead reported the efficacy of cognitive control training in food consumption in an obese population.
People with cognitive impairment following brain injury often lack problem-solving skills, and a Web-based approach could be useful in rehabilitation [65]. The ProSolv app from Powell and colleagues [65] could be a useful tool to help solve this issue. The deficit in problem-solving was trained through the creation of a personalized problem-solution list and with the possibility to use the app as a resource for remembering the steps to effective problem solving.
This cognitive dimension was analyzed in different samples and with different meanings by the authors. Tacchino and colleagues [66] and Zmily and colleagues [68] explored how to train memory in patients with diseases that cause cognitive impairments: multiple sclerosis and Alzheimer disease, respectively. As they referred to different kinds of populations, the authors explored different kinds of memory. Tacchino and colleagues [66] focused on working memory training, which can lead to changes in a healthy individual's brain structures that can improve cognitive function, useful in the daily life. The improvement is demonstrated in cognitively impaired patients as well. Their study focused on multiple sclerosis, as it is a cognitively disabling condition and affects all age groups. Another disease that has serious effects on cognitive impairment is Alzheimer disease. Memory impairment in Alzheimer disease patients was the focus of the work of Zmily and colleagues [68], which focused on recall ability training to help individuals retain critical information longer and consequentially improve their quality of life.
The research of Lu and colleagues [62] and Shellington and colleagues [63] investigated memory impairment in older populations. Shellington and colleagues [63] considered older adults with and without subjective cognitive complaints and mild cognitive impairment. In the study, the authors tried to train memory through physical activities. They stated that physical exercise was associated with higher cognitive function and used a square step exercise that was proven to train memory skills. Lu and colleagues [62] studied age-related memory decline and its effect on recollection ability during information finding and retrieval in healthy older adults. Memory was trained with 4 tasks: discrimination, visuomotor, respelling, and calculation.
Lu and colleagues [62] reported some evidence on age-related decline in executive function and performance; these abilities are generally affected by decreases in working memory functioning and by the perception of time. Deficiency in this domain is related to future functional impairment. Neurochemical, localized, and process aging theories indicate that age-related cognitive changes also affect executive functioning. Brain Win, the app developed by authors, stimulated executive function in all game contexts with 4 types of tasks (discrimination, visuomotor, respelling, and calculation). Shellington and colleagues [63] studied executive function related to physical exercise. They considered physical activities as a means to train executive function. Their app, Healthe Brain, suggested a series of exercises, called square step exercises, to implement the cognitive domain.
Visuospatial Function
Brain Win, the app developed by Lu and colleagues [62], stimulated the visuospatial function with 2 tasks: Go to the Market and Super singer. Brain Win was specifically developed to improve visuomotor ability in older adults; visuospatial function is affected by age-related cognitive changes including visuospatial attention, memory, and orientation decline. Visuospatial function is the focus of the work by Shellington and colleagues [63] as well. Their study combined physical activities with cognitive training. In particular, they focused on a series of activities called square step exercises. These exercises could be described as a visuospatial working memory with a cued stepping response also known as mind-motor exercise.
Four studies considered the cognitive domain of attention. In particular, Bless and colleagues [67] focused on an app to train auditory attention, based on the forced-attention conditions of the consonant-vowel dichotic listening paradigm. Individuals have to listen to different auditory stimuli simultaneously in both ears while paying attention to only 1 of the sounds. According to the authors, this paradigm could be considered as an analog task in some everyday life situations in which people are asked to effectively master different and confounding auditory events. The authors reported that some deficits in auditory attention could also be found in clinical conditions like schizophrenia, preterm–born adolescents, dyslexia, and aging. In their study, the authors tried also to see if the trained task has transfer effects on cognitive interference and attentional task in daily visual and auditory domain activities.
The Attention Training Application by Hill and colleagues [60,61] is based on the dual n-back training paradigm and targets attention in elderly people. The authors reported that through aging, some aspects of attention could tend to decline—for example, with increasing age, the ability to divide or switch attention could decline. Attention is a cognitive function that has a pervasive influence on several daily activities. Thus, its training may also lead to improvements in other cognitive performance aspects and enhance the appropriateness of several daily life activities. Specifically, the authors highlighted that the effect of the dual n-back task could be transferred to other cognitive abilities.
Also, the Brain Win app, developed in a working prototype for older adults by Lu and colleagues [62], targets the cognitive domain of attention. This app directly stimulates attention with 4 types of games addressing discrimination, visuomotor, respelling, and calculation tasks.
Two studies directly focused on training the cognitive domain of language. Lu and colleagues [62] started by reporting evidence of a decline of language functioning in elderly people. Specifically, neurochemical, localized, and process aging theories demonstrate age-related cognitive changes affecting language. Language is connected with various cognitive aspects; a decline in this domain could also affect sentence understanding and text recalling. In Brain Win, the app developed by the authors, language is stimulated through 2 context games (Finding Objects During a Phone Call and Super singer) that were connected to 2 types of abilities, discrimination and respelling, respectively. Lorusso and colleagues [59] focused on improving language ability in children with language impairment and typically developing children. Their system aimed to improve semantic competence and structural knowledge with various activities. The system is made up as an integrated combination of a tablet, a group of plastic toys, the near field communication technology, and a custom app that allows children to play with various activities to train specific cognitive processes and abilities such as mental representation, conceptual networks, and semantic versus structural world knowledge. These aspects are especially relevant in speech and language development and functioning.
Only 3 out of 10 studies directly evaluate the apps in improving cognitive abilities. Blackburne and colleagues [69] evaluated the efficacy of the NoGo app in having an impact on cognitive control and in particular on inhibitory control. Compared to a control group, the authors found in people using the app an increase of cognitive restraint evaluated with a self-report questionnaire. Regarding the exercise conveyed by the app, authors showed a significant effect in improving inhibitory control in the training group. Other measured outcomes were self-reported food consumption and attitudes toward food and diet. Results demonstrated the effectiveness of the app in improving even these aspects.
Bless and colleagues [67] concluded that the training of auditory attention through an app is feasible and successful. After 21 days of practicing, participants were found to have an increase in auditory attention. This is supported by the fact that the training group showed an increase in the performance of the exercise itself and in brain activation measured with functional magnetic resonance imaging.
Finally, Powell and colleagues [65] focused on the efficacy of their app and evaluated its effectiveness in improving problem-solving ability, but no significant effects of the cognitive training were found in comparing an intervention group using ProSolv and a control group performing traditional cognitive training. Other authors focused attention on subjective evaluations of their apps [59,61-63,66,68], but these studies lack of data regarding the effects produced by the apps on cognitive abilities.
This systematic review provides a useful, clear, and comprehensive overview of the current state of the art in available apps for cognitive training. However, this work also raises some critical issues regarding the application of this kind of training in clinical and research practice for breast cancer patients. While some issues are broader and relevant to the field of cognitive training apps, others are more specific and directly related to their application in a cancer patient population.
General Issues in Cognitive Training Apps
The majority of the articles included in this review have the primary aim of evaluating app usability, acceptability, feasibility, and user satisfaction; only a few of them directly focus on demonstrating efficacy in improving cognitive functioning. Only 2 [67,69] out of 11 studies report significant and quantitative amelioration in cognitive performance. Even if feasibility is important, it should be noted that the objective efficacy of the apps has not been measured in the majority of the relevant articles. For several apps, we could not establish whether the training effectively improved the targeted cognitive domains.
In addition, some definitional and conceptual issues about cognitive functions also emerge. Specifically, there is a vast heterogeneity in the definition and conceptualization of cognitive function across studies, with similar cognitive domains being labeled in different ways (eg, executive functions may include visuospatial attention, attention, and so on). Moreover, targeted cognitive functions are not unique or consistent across studies, with only marginal overlap between studies. Some cognitive functions (eg, memory) cover heterogeneous abilities (eg, working memory, short-term memory, long-term memory) encompassing specific functions that can be selectively impaired in some diseases and not in others. Thus, it is difficult to draw conclusions on which cognitive domain could benefit from app training. Given the aforementioned issues, it is critical to properly evaluate the clinical efficacy and effectiveness of these apps.
Specific Issues in Cognitive Training Apps Applied to Cancer Patients
Taken together, these results show that there are apps that are best candidates to target cognitive functions generally impaired in women with breast cancer. However, the feasibility, usefulness, and efficiency of cognitive training in this particular population should not be automatically taken for granted.
Relevant articles included in our review employed highly heterogeneous samples of subjects: only a few apps have been tested on patients, such as people with Alzheimer disease [68] or multiple sclerosis [66]; most have been evaluated on a healthy general population sample of adults or children. This heterogeneity is also indicative of the different needs of these diverse populations.
People with breast cancer may benefit from using available interventions or to-be-developed apps for this specific category of patients. In fact, breast cancer patients somehow reside in a class between mildly or severely cognitively impaired patients and healthy general population subjects because they display objective cognitive impairments or report cognitive problems [9] but they still can properly work and have an active and preserved social life. On one hand, they do not display a degenerative disease with a progressive worsening of global or selective cognitive functioning. On the other hand, they are aware of and worried that their cognitive worsening could interfere with daily routines and everyday life. Thus, they are strongly motivated to be involved in a cognitive training program. Worthy of note, breast cancer patients usually display a high level of distress symptoms and serious psychological side effects [5,9] that can influence subjective perception of cognitive functioning and could potentially interfere with training activities.
Finally, the summarized papers, apart from Lu and colleagues [62] and Shellington and colleagues [63], reported training interventions on a single cognitive domain. However, women with breast cancer often display difficulties and deficits in several cognitive domains. Thus, it could be relevant to design, develop, and implement an ad hoc app targeting the various cognitive function domains for breast cancer patients.
Our study highlights the fact that cognitive training apps are becoming more present in rehabilitation of different diseases. It is noteworthy that none of them has been developed to counteract cognitive impairment in breast cancer patients, a specific population in which short- and long-term cognitive difficulties have been underlined. Thus, currently there are no available cognitive training apps that meet the needs of breast cancer survivor women. Available apps lack strong specificity for oncological breast patients both from the point of view of the cognitive functions that should be addressed and for the psychological complexity that these patients display. In fact, the psychological and physical impact of breast cancer on cognitive impairment should be taken into account as well. As a specific population with specific needs, it is necessary to create an app that considers their deficit as different from the deficit that another population of patients could have (eg, neurodegenerative conditions). Medicine is evolving to consider not only the patient's physical safety but also a personalized approach to disease [70,71]. From the patient empowerment perspective, it is very important to give breast cancer survivors reliable means to improve and train their cognitive functioning because of the huge impact of cognitive complaints on the quality of life and patient empowerment [72]. Moreover, women with breast cancer may benefit from using a mobile or Web-based tool to improve cognitive functioning, effectively manage their daily activity, and properly cope with everyday difficulties. This would be especially helpful to foster breast cancer patient perceived self-efficacy and manage their anxious and depressive symptomatology. We conclude that further studies should test the feasibility, usability, and effectiveness of available cognitive training apps in women with breast cancer. Because of the complexity and multidimensionality of the cognitive difficulties affecting this cancer population, it may be useful to design, develop, test, and implement an app with the specific aim to train cognitive impairment in breast cancer patients.
This project has received funding from the European Union's Horizon 2020 Research and Innovation Program under grant agreement number 643529. This manuscript reflects the authors' views; the European Commission is not responsible for any use that may be made of the information it contains.
GM and LV reviewed the literature and wrote the main part of the review. SFMP, DM, KM, and GP supervised the work, reviewed the manuscript, and provided conclusions.
Multimedia Appendix 1
Summary of study characteristics in terms of study type, aim, and sample.
PDF File (Adobe PDF File), 30KB
Summary of main aspects of apps and their evaluation.
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COGNI-TRAcK: Cognitive Training Kit
Edited by G Eysenbach; submitted 23.04.18; peer-reviewed by C Păsărelu; comments to author 06.06.18; revised version received 02.07.18; accepted 16.07.18; published 19.03.19
©Laura Vergani, Giulia Marton, Silvia Francesca Maria Pizzoli, Dario Monzani, Ketti Mazzocco, Gabriella Pravettoni. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 19.03.2019.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.


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Q: Div width auto fit to screen/parent element I am sure this is simple but...
I have the following:
http://jsfiddle.net/SUBH3/1/
HTML:

gest

CSS:
#wrapper
{
    position:absolute;
    top:0px;
    left:0px;
    width:100%;
    height:100%;
}
#panel1
{
    position:relative;
    top:0px;
    left:0px;
    float:left;
    height:100%;
    width:35px;
    background-color:blue;
}

#panel2
{
    position:relative;
    top:0px;
    left:0px;
    float:left;
    height:100%;
    width:240px;
    background-color:red;
}

#panel3
{
    position:relative;
    top:0px;
    left:0px;
    float:left;
    height:100%;
    background-color:green;
}

What I want is to have the final green panel fill the rest of the space. I have tried a few things but cannot do it. I can use a table to achieve what I want, which is what I will probably do, I just want to know how I can do this with css?
I have tried this with list elements too, but end up with the same problem.

A: I get it I get it.  You're floating the other two panels, but if you don't float the last one, it will fill the rest of the space.  Normally it would float around the bottom of the left two containers, but because they are 100% height, it doesn't.
Thus you should use this style rule:
#panel3
{
    height:100%;
    background-color:green;
}

http://jsfiddle.net/hGWyF/

A: Remove both float and position, it'll fill the rest of the space by default because all of the elements have a height of 100%.

redpajama_set_name: RedPajamaStackExchange


Sorry for the confusion.I live in US. If i buy a property in banglore can i register it on my name?.I heard Registration process in Karnataka(b'lore) is stopped Temporarily .Is it true? .Please do respond ASAP.
how do i send money to kolkata from bangalore without have any bank accounts or something ?
i wanna send money to b'lore …i dunt have any bank a/c or credit card or so……what do i do ?


text:
#Recording
10 Tips To Record A Band (Without Walkouts Or Breakups)
Do you have an important band-recording project coming up? Want to know some inside tricks to capture the perfect band recording? Over the years, we've spoken to all of the top engineers and producers, who've given us the inside track – from getting to know the band, to getting the perfect takes, every time… 1. […]
Do you have an important band-recording project coming up? Want to know some inside tricks to capture the perfect band recording? Over the years, we've spoken to all of the top engineers and producers, who've given us the inside track – from getting to know the band, to getting the perfect takes, every time…
1. Watch the band play live
When you're lining up a recording session with a band in the studio, go and see them play live as many times as you can beforehand. See how they gel on stage, and work out how important the 'performance' is as part of their overall sound.Often, you'll want to preserve the essence of their live identity during the recording.
The legendary Mike Howlett (OMD, Flock Of Seagulls) told us: "Has the performance got any magic? Do you get that little tingle from the singer, especially the vocal? If a vocal doesn't cut it, it's just a piece of crap, you know? You might spend a lot of time getting a great snare sound, but so what? It's about the song, arrangement, and performance."
2. Get to know the artist
Don't start stalking the band, but do try and hang out with them before the recording session, to work out the dynamic, who is calling the shots, who's there to make the numbers up and who's confident, or not, in their own playing ability. You might need to focus on the less confident and let the more assured breathe a little in your studio environment. The one who's deciding the band's sound is your best friend, as we shall see…
3. Find out exactly what they want
Don't assume the band want a particular sound, ie, the one from their last album or that sound you heard from them when they played live. Talk to them, communicate, get some reference points before you start recording. Is there a particular artist they're trying to emulate, or use as a starting point? Is there a type of production sound they're aspiring to? Does the guitarist have a particular sonic direction they want to explore?
The same goes for everyone else. Also, be sure to concentrate on the sound that the vocalist wants, as everything else will hang around this recording, which leads nicely to…
4. Start with the vocal
Most producers and engineers put more effort into the vocal recording than any other part. It's the element that listeners are naturally attuned to, which often carries the hook and, of course, the message of the song. "If you get the vocal right, you've done 50% of the job," says Depeche Mode producer Ben Hillier. "The music has to fit the singing, not the other way around. So if you have a certain amount of time booked with the band, spend a large proportion, and the first part of it, with the vocalist."
5. Prep, prep and more prep
The last thing the band wants when they enter your studio is to hang around waiting for you to plug stuff in, find some mics, repair some old outboard and make frantic calls for half an hour. The night before the recording, make sure you're ready. Set up your chosen mic for the vocalist (with one or two alternative choices ready) and put that pop shield in place. On the morning of the recording, make sure everything's plugged in and your DAW is set up. Check connections, and check again! Get ready, press record…
6. Relax… and just do it
Bands – and in particular, vocalists – will give their best performances when they're relaxed. With a vocalist, this might mean doing the recording in the evening, but in almost all cases, dim the lights. Or, in extreme Michael Jackson-type cases, switch them off (he liked recording in the dark) and prepare to be an audience member.
As top producer Mick Glossop says: "There's no screaming crowd of fans giving them that energy, so you have to find artificial ways to help them. Someone once told me that the singer has got to feel like you are their biggest fan in the control room, but you do have to temper that with some criticism – it's no good saying everything they do is good."
7. Our guitarist is electric
When recording the electric guitar, it's important to go with the guitarist's sound. Don't suddenly present them with unfamiliar gear you think sounds great. They need to 'know' their sound – and that means both guitar and amp. There are several tried-and-trusted ways of recording a guitar amp, but possibly the best guitar-recording producer out there, John Leckie (Stone Roses, Radiohead) told Reverb.com about a slightly different approach: "Use a Shure SM58 – I prefer a 58, as the 57 has more top. Put it close to the grille, slightly off-centre, with a Neumann U67 right up close. Even if it's a deafeningly loud Marshall amp you should be able to put a 58 and a 67 right up close. Then record it flat."
If things go a little Spinal Tap, you may have to assert your authority.
8. Acoustically yours
There are about as many ways of recording an acoustic guitar as there are acoustic-guitar types out there. You can set up a single dynamic microphone, or place a couple of condensers at right angles either horizontally or vertically. But the best single-mic method is simply to place a large-diaphragm condenser pointing at the 12th fret of the guitar – and that will give you a very balanced tone. Place it as close as three-to-six inches from the guitar for a boomy or bass-heavy sound, or eight-to-12 inches away for a more natural sound.
9. One drum mic'ing idea
Again, there are as many drum mic'ing methods out there in studio land as there are drummer jokes. But one that comes up again and again as we chat to top producers and engineers is the holy Glyn Johns (The Rolling Stones, The Who) method. As gear guru and producer to the stars, George Massenburg told us: "It came from using a couple of Beyerdynamic M 201s for the overheads – which will cost you a couple of hundred bucks – a Shure SM57 for the snare and a kick mic, which was the Sennheiser e 902. You're done for well under a thousand bucks."
10. Experiment (if you can)
These are just guides, of course. While most producers have tried-and-tested methods of recording the various band instruments, they all try and experiment and push the boundaries a little, depending on the recording situation they're in. So, once you get some fundamental recording ideas – very much those listed here – try and spend some time pushing those boundaries. Making a good band recording is doable if you follow the rules listed here, but making a great band recording is achieved via years of experience, breaking rules and making your own.
First time recording a band? Check out our short tutorial to get yourself up to speed.

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: Локальное изменение массива изменяет состояние в Store Непосредственно сам Store

import loadMore from '../assets/js/loadMore.js'
export default {
state:{
    messages: [],
    messagesMain: []
},
mutations:{
    setMessage (state, payload) {
        state.messages = payload
    },
    setMessageMain (state, payload) {
        state.messagesMain = payload
    },
    loadMessages (state, payload) {
        state.messagesMain = [...state.messagesMain, ...payload]
    }
},
actions:{
    setMessage ({commit}, payload) {
        commit('setMessage', payload)
    },
    setMessageMain ({commit}, payload) {
        commit('setMessageMain', payload)
    },
    loadMessages ({commit, getters}) {
        let res = getters.getMessageFilter.slice()
        commit('loadMessages', loadMore(res))
    }
},
getters:{
    getMessage (state) {
        return state.messages
    },
    getMessageFilter (state) {
        return state.messages.filter(mess => {
            return !mess.main
        })
    },
    getMessageMain (state) {
        return state.messagesMain
    }
  }
}

loadMore function

В данную функцию я передаю переменную полученную из State через getters. В самой функции я данную переменную присваиваю новому массиву так что бы они были независимыми, однако при изменении новой переменной меняется значение в State

export default function loadMore (res) {
let sm = [];
sm = res.slice()
const messages = [];

if (sm.length > 2){
    for (let i = 0; i < 2; i++){
        sm[i].main = true
        debugger
        messages.push(sm[i])
    }
    return messages
}else{
    for (let i = 0; i < sm.length; i++){
        sm[i].main = true
        messages.push(sm[i])
    }
    return messages
  }
}


Not that we've hated something before that will prevent us from liking it in the future.
Trend changes, and so does technology. When a something that we've never seen, heard or thought of before, has been introduced, most of us will become alienated by it. While it's an innovation created to aid us, we may feel threatened and scared. We put on our defense mode to prevent that particular thing to disturb us.
We were curious, but also intimidated at the same time. We were familiar with the world we lived on, and that didn't necessarily make us able to embrace new things we had no idea what it does or what it's capable of doing. Some of us go further to even hate it.
But as time passes, trends will change. And by that time, the thing that scared us, may eventually turn into one common thing. It's becoming a hype. We're not hating it anymore, in fact, we may fall in love with it.
So trends can change technology, and in turn technology will change the trends. This is why our society kept on transforming. Powerful trends are reshaping our views on things as well as how businesses work. It drives new technologies to emerge, shifting the talent needs and most of all, changing our behavior and perceptive.
Here we see that us humans tend to overestimate what we can do in a day, but underestimate what we can do in a year, and have no idea what will happen in a decade.
One example is when Google that built its empire by creating a search engine. As the most sophisticated of its kind, it made us curious but happy. But it scared us of what it can do.
When it introduced location-sharing for its Maps app, we're happy. But that feature is similar to Latitude, a product Google had in the past that had a very similar feature, but scared us. The same goes with Snapchat's glasses. It thrills us and made a great debut. But that moment wasn't long after Google failed with Google Glass due to privacy concerns.
As time passes, new technologies that are based on older technologies rise, decaying others that won't follow. There is no reason to say that trends don't have a role here.
We demand faster things. Better and most sophisticated but yet still simple to use. We want automation to aid tasks; we become happier as we become lazier. We develop and pay for things that put us forward to the future by introducing more distraction.
This is the race to connect everything. We have smartphones, and yes we are having IoT. We want self-driving cars and robots to do our labor. There is no doubt that technology is giving us a greater sense of independence. The influence of technology towards trends is keeping us glued to screens.
Not just to specific fields, closer analysis conclude that the scale of technology affects everything that include economic growth, globalization, political and individual change.
Regardless of your industry, it's essential to consider the impact of these changes on your work. Changes happen, happened and will happen. They can start either from new emerging technologies, or the needs for us to change because we just want to move forward.


text:
Poorest Nations Give Green Light on Emissions Cuts
by Xander Vagg | Apr 2, 2013 | Monitor
In a declaration that surprised many in the United Nations community, the poorest nations of the world announced today that they are now prepared to commit themselves to binding cuts in their greenhouse gas emissions.
Common But Differentiated Responsibility
For years, UN negotiations designed to combat climate change through international emissions-reducing agreements have stalled or petered out since the initial Kyoto Protocol agreements of 1997. Many observers of the process have suggested that one reason for the stall has been disagreement over the idea of "common but differentiated responsibility" for emissions reductions. First outlined in the 1992 Rio Earth Summit, agreed at the 1995 Berlin summit, and enshrined in the Kyoto Protocol, this principle says that:
"In view of the different contributions to global environmental degradation, States have common but differentiated responsibilities. The developed countries acknowledge the responsibility that they bear in the international pursuit of sustainable development in view of the pressures their societies place on the global environment and of the technologies and financial resources they command."
Essentially, conflict in the UN General Assembly and climate negotiations led by the UNFCCC has arisen over the responsibilities of developing states regarding emissions reductions. Until now, some developing states have refused to move to reduce their emissions, arguing that climate change is a problem that they had no hand in creating. Developed states like the U.S. and Canada have in turn refused to commit to internationally agreed-upon emissions measures without guarantees from the developing states.
However, given this 180 degree shift by the Group of Least Developed Countries in the UN, future emissions reduction negotiations might proceed more smoothly, and with more tangible outcomes. The LDC group is a major negotiating bloc at the UN representing 12% of the world's population. By acting first to cut emissions, the LDC's might be able to encourage hesitant developed states to match carbon reductions during upcoming UNFCCC negotiations in Bonn and beyond.
According to lead negotiator Quamrul Chowdhury of Bangladesh, the LDC Group has agreed to binding emissions cuts by all signatories to the Kyoto Protocol, not just by industrialized countries. However, Chowdhury also suggested that developed nations must now do more to match their developing peers while still respecting their differentiated responsibilities regarding climate change. Adaptation efforts in Bangladesh, Nepal and Mozambique could provide a model, according to Chowdhury.
The BASIC Truth
Of course, this game has never been about the LDC's, because their emissions are so low that any cuts will not have a real impact on global emissions. The real conflict has always been between fast developing countries like the so-called BASIC group of Brazil, South Africa, India and China and developed nations. Annex I countries, like the U.S. and EU have argued that uncapped emissions in fast developing countries mean that capped emissions can simply 'flee' to uncapped areas – and this 'carbon flight' would mean that the climate remains at risk. Up to now, BASIC countries have called for 'solidarity' among developing countries (including LDC's) in opposing any binding caps. With the LDC's now calling for a cap on emissions, it is clear that the BASIC group's efforts have simply been a self-interested way to ensure their emissions remain uncapped.
By reversing their position on binding emissions cuts, the states of the LDC Group have removed a major obstacle to climate change mitigation efforts. They have changed the entire framework of this debate and committed to solving a problem they (for the most part) had no hand in creating. The ball, at least for the time being, is indisputably in the rest of the world's court.


text:
BigPicture Natural World Photography 2021
The Grand Prize winner will receive $5,000 in cash.
Deadline: 1 March 2021
Entry fee: $25 for up to 10 single image submissions in any category
Website: https://www.bigpicturecompetition.org/
The annual BigPicture: Natural World Photography Competition encourages photographers from around the world to contribute their work to this photo competition that will both celebrate and illustrate the rich diversity of life on Earth and inspire action to protect and conserve it through the power of imagery. The winning images are exhibited at one of the most prestigious science institutions in the world in San Francisco, California, USA.
The BigPicture Photo Competition has the following categories: Art of Nature | Aquatic Life | Winged Life | Landscapes, Waterscapes, and Flora | Terrestrial Wildlife | Human/Nature | Photo Story: Out of the Ordinary.
The first place winners of the seven categories will each receive $1,000 in cash.
BigPicture is open to all photography enthusiasts and professionals alike worldwide to compete for a chance to win the $5,000 grand prize.
Entrants retain ownership and all other rights to submitted photographs subject to the following: By entering the Competition, each Entrant grants to the Academy a non-exclusive, irrevocable license to reproduce, publish, and display submitted images directly relating to the Competition in all media throughout the world in perpetuity. This includes but is not limited to use in the context of the Academy website and social media sites, the exhibition of winning images* at the Academy, and and and all promotional and marketing materials regarding the Competition and Exhibition. In other circumstances, commercial opportunities may exist for awarded photographers to benefit from the use of their images, such as print sales or merchandise. Where such a commercial benefit is likely to arise, permission will be sought in advance and terms and conditions will be agreed upon with the photographer.
Nature Landscape


A true English hunting breed, the Pointer is an agile, athletic dog that is proud and elegant. He has a powerful, muscular body that gives him a noble confidence in the field. He also is a suitable family companion that is affectionate and protective at home. The enthusiastic, intelligent Pointer needs ample exercise and mental stimulation, and his smooth, dense coat requires minimal grooming.
The Pointer, which originated in England in 1650, was the first breed used to point game.


QANTASLink B717-200 VH-NXD Kalgoorlie Technical Issue.
QANTASLink Boeing 717-23S VH-NXD operated QF1886 Perth – Kalgoorlie this afternoon, however the return QF1887 was cancelled due to a technical issue. The aircraft was able to position Kalgoorlie – Perth during the evening as QF6277.


text:
Alderwood Manor is a census-designated place (CDP) in Snohomish County, Washington, United States. The population was 10,198 at the 2020 census. Prior to the 2000 census, Alderwood Manor was counted as part of the Alderwood Manor-Bothell North CDP.

Geography
According to the United States Census Bureau, the CDP has a total area of 4.8 square miles (12.4 km2).

Parts of Alderwood Manor lie in the Lynnwood MUGA (Municipal Urban Growth Area). Depending on location, buildings in Alderwood Manor may use either Lynnwood, Bothell, or Brier mailing addresses.

History

Alderwood Manor was a community that is now the cities of Lynnwood, Brier, and Mountlake Terrace. Alderwood Manor was a farming community where most residents raised chickens. Alderwood Manor was connected to Everett and Seattle by the interurban trolley system. Most signs of Alderwood have since disappeared but in 2004 Lynnwood's Heritage Park opened. The Heritage Park has some old buildings of the Lynnwood area, such as The Wickers Building, which served as Alderwood's main store and post office from 1919-1960s. Other buildings included Car 55 of the interurban.

In 1979 Lynnwood's largest tourist attraction, the Alderwood Mall was built.

The only Alderwood Manor building still in the same place as when it was built is the old Masonic Temple. The Manor Hardware building (originally used as a schoolhouse in the early 1900s, but which had been vacant for many years) was demolished in 2015. Both locations are just off of 196th St SW in Lynnwood. Some private homes still stand in the area as well.

Demographics

2000 census
As of the census of 2000, there were 15,329 people, 5,558 households, and 4,090 families residing in the CDP. The population density was 3,194.6 people per square mile (1,233.0/km2). There were 5,743 housing units at an average density of 1,196.8/sq mi (462.0/km2). The racial makeup of the CDP was 52.12% White, 14.62% African American, 0.86% Native American, 9.82% Asian, 0.46% Pacific Islander, 1.59% from other races, and 3.53% from two or more races. Hispanic or Latino of any race were 26.97% of the population.

There were 5,558 households, out of which 40.6% had children under the age of 18 living with them, 60.4% were married couples living together, 9.2% had a female householder with no husband present, and 26.4% were non-families. 19.4% of all households were made up of individuals, and 5.9% had someone living alone who was 65 years of age or older. The average household size was 2.75 and the average family size was 3.17.

In the CDP, the age distribution of the population shows 28.1% under the age of 18, 7.1% from 18 to 24, 34.5% from 25 to 44, 21.6% from 45 to 64, and 8.7% who were 65 years of age or older. The median age was 35 years. For every 100 females, there were 98.3 males. For every 100 females age 18 and over, there were 96.4 males.

The median income for a household in the CDP was $61,199, and the median income for a family was $68,679. Males had a median income of $45,807 versus $33,099 for females. The per capita income for the CDP was $24,012. About 2.4% of families and 3.6% of the population were below the poverty line, including 4.0% of those under age 18 and 2.4% of those age 65 or over.

Notable residents
Edward Nixon, consultant and brother of President Richard Nixon

References

External links
 Alderwood Manor Heritage Association
 Heritage Park at the City of Lynnwood website

Census-designated places in Snohomish County, Washington
Census-designated places in Washington (state)

redpajama_set_name: RedPajamaWikipedia


The inaugural issue of Ethics & Human Research (E&HR) marks an exciting milestone in The Hastings Centers' 40‐year history of publishing a journal that focuses on the ethical, regulatory, and policy issues related to research with humans. Like its predecessor, IRB: Ethics & Human Research, E&HR will publish conceptual and empirical analyses on a wide range of topics related to the human research enterprise.
The journal's name change conveys to the global community of authors and readers that E&HR is not solely about issues related to institutional review boards (IRBs) in the United States. The title shift provides an opportunity to identify new ethical, policy, and regulatory challenges that rapid developments in science, medicine, and regulatory frameworks bring to the conduct and oversight of human subjects research in the United States and elsewhere. Along with publishing work that investigates new challenges, E&HR aims not only to draw attention to unresolved issues but also to broaden the scope of issues for investigation and analysis in the field of human research ethics. The pieces in this inaugural issue identify several new challenges and hint at some of the unresolved issues and broader topics that merit further attention.
In the lead article, about phase I clinical trials with healthy volunteers, Jill Fisher and Rebecca Walker propose adapting the ethical concepts and oversight mechanisms that are applied to research with nonhuman animals to enhance the welfare of healthy human volunteers in such trials, improve oversight of the trials, and more critically assess their scientific value. For example, using a "model‐organism" approach to advance the ethical framework for phase I healthy‐volunteer trials would draw attention to shared structural features of animal and human research. As is the case with animal subjects, human participants in healthy‐volunteer trials are typically confined at a research facility. Participants in these trials cannot leave the study site during the duration of the trial—which can last 24 hours or more—unless they withdraw from the study. While animal research regulations require adherence to specific health and welfare conditions for the confinement of animals used in research, the authors point to gaps in ethics and regulatory standards on these matters for the confinement of healthy human volunteers in phase I trials.


text:
using System;
using System.Windows.Forms;

namespace IDE
{
    public partial class Ajuda : Form
    {
        public Ajuda()
        {
            InitializeComponent();
        }

        private void Ajuda_Load(object sender, EventArgs e)
        {
        }
    }
}

redpajama_set_name: RedPajamaGithub


Mississippi Barbell was chosen as only one of seven sites in the South East Region to host, conduct, and coach the six hour long Athlete Development Camps in 2018. Camps will occur every month and start at the low price of $99.
New to olympic weightlifting, coming from another sport, or have less than three years of dedicated weightlifting experience? Come learn from the only USAW Athlete Development Coaches in the state in this 6 hour course catered to your fitness needs.
Are you under 17? Is your child under 17? Do they want to learn the olympic movements in a safe environment and under expert eyes? Then sign up for our Youth only USAW sponsored weightlifting camps. Athletes get six hours of training under National coaches who have worked with beginner youth athletes (with no experience) and developed them into national level athletes.
Been involved in weightlifting for a few years? Maybe you've been excelling in functional fitness and want to improve your movements? Then this is the camp for you. Six hours of instruction are included.
Missing snatches forward, behind, or just can't get under the bar no matter you've been doing? Come to a six hour camp and have our expert coaches instruct you in a small group setting to tune up your technique so you can PR sooner rather than later.
Clean and jerks win competitions. Don't let your jerk stifle your growth as an athlete. Come fine tune your clean and your jerk in our six hour course taught by experts with over two decades of experience.